Role of α2-agonists in the Treatment of Acute Alcohol Withdrawal

Andrew J Muzyk PharmD; Jill A Fowler PharmD; Daryn K Norwood PharmD; Allison Chilipko PharmD


The Annals of Pharmacotherapy. 2011;45(5):649-657. 

In This Article


To our knowledge, this is the first comprehensive review to examine the role of α2-agonists, including dexmedetomidine, in the treatment of alcohol withdrawal. The influence of noradrenergic neurotransmission in alcohol withdrawal has been established; however, the benefits of solely targeting this neurotransmitter or neuronal pathway are limited. Clinical trials with clonidine and case reports with dexmedetomidine have reported benefit with this drug class in ameliorating the symptoms of sympathetic overdrive that are part of the alcohol withdrawal symptom constellation. Although α2-agonists provide an additional pharmacologic agent in the clinician's armamentarium, they offer no benefit in the prevention or treatment of alcohol withdrawal seizures or delirium tremens. Therefore, we believe that the only role for α2-agonists is as adjunctive medication to benzodiazepines.

Positive findings from case reports on use of dexmedetomidine, coupled with its ease of use, safety profile, and lack of intubation requirements, make this medication a valuable choice for alcohol withdrawal in the ICU. Lastly, because dexmedetomidine offers advantages over medications currently used in the ICU, further study is merited to fully elicit its place in the alcohol withdrawal treatment algorithm.


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